East of England

Bedfordshire, Luton & Milton Keynes

The merged CCG Governing Body meeting in March revealed that they were depending upon costly consultants from Deloitte to develop their plans for up to £56m of “efficiency savings), which involve triangles and envelopes:

“Between the submissions, more triangulation is needed across workforce, activity and finance information. Each organisation across the system has been asked to focus on this internally, and Deloitte will be supporting this work through the NHSE triangulation tool. As mentioned above, we will need to do more triangulation with our non-acute partners, and put in place a system transformation and system efficiency programme to ensure we can live within the envelope provided.”

“Taken together, with the current financial plan gap and already identified mitigations – the CCG has a risk adjusted financial gap of c£14m [up to £18m].”

Cambridgeshire and Peterborough

The System Partnership Board meeting on March 30 projected a ‘break even’ for all partner organisations …  but only on the most tenuous basis:

“The Board is asked to note that the plan contains a significant level of risk, including:

  • Delivery of c4.8% efficiencies, including a significant reduction in covid-related expenditure
  • The … assumes a significant level of ERF [Elective Recovery Fund] contribution can be achieved in-year (net £52m) as well as a reduction in covid costs.
  • … our plan assumes c2.8% inflation but we know that economic pressures will be a challenge to this, as well as ongoing challenges on Continuing Healthcare and GP Prescribing.” (p4)

Despite ministers’ constant claims of extra funding, the finance paper warns:

“Effectively, this will require total system expenditure to remain at or marginally below planned inflation (flat real),” and this is far from certain:  “the plan articulates total unmitigated risks of c£77m.”

North West Anglia FT (Peterborough & Stamford) Board in April noted “Virtual Wards feature heavily in the Operating Framework for 2022/23. There is an expectation that we build at pace Virtual Wards to accommodate 15% of patients across the C&P system who otherwise would be delayed in hospital or admitted into the Trust.  But the Trust is less than galvanised into action:

“We would be required for our population to supply 250 ‘virtual’ beds.  … In line with this we implemented two virtual wards at NWAFT offering up to 30 beds.” (p76)

Hertfordshire and West Essex

No clear information on the state of play in this ICS. The Trusts are all predicting deficits. West Hertfordshire Teaching Hospitals Trust May Board meeting was told “The [22/23] plan at this stage results in a £15.3m deficit of income over expenditure. … Other allocations may need to be re-directed if deficits are to be avoided.” (p409)

East & North Hertfordshire Hospitals’ May Board meeting shows an underlying deficit for every month of 2021-22, resulting in an above forecast deficit of £54m that was covered by non-recurring income (p92). Its Elective Recovery Board Update avoids any mention at all of the cost and affordability of delivering the proposed increases in elective care. (p144 ff)

Princess Alexandra Hospital Trust’s April Board papers show: “The financial plan was discussed and members were partially assured [sic] as further work is required to reduce the planning gap of £14.8m.” (p132)

Mid and South Essex Health and Care Partnership

March meeting in common of Basildon & Brentwood CCG, Castle Point & Rochford CCG, Mid Essex CCG, Southend CCG and Thurrock CCG notes repeatedly that the system faces an underlying deficit, and the need to:

“Achieve key statutory financial duties including delivery of the system financial control total, value for money and reduction of the underlying system deficit.”.

“Initial expectations were for a system expectation of c. £65m-£70m of efficiencies during the year, both cash-releasing savings and productivity improvements. As the financial plans have developed over the past month this challenge has risen to c.£85m…” (p87)

However Mid and South Essex had seen hospital waiting lists size increased by around 39,000 patients since start of financial year to 128,605 – with 4,571 patients waiting over 52 weeks and 889 over 78weeks (18 months).

Mid and South Essex Foundation Trust has been concentrating its efforts on encouraging more patients to travel to private hospitals (ISPs) for treatment

“397 patients have been identified from the admitted waiting list for transfer to ISP from the digital patient questionnaire.

“… Sharing waiting times with patients is resulting in increased patient appetite to travel to ISPs” (p4)

Norfolk and Waveney

The CCG’s 2022/23 Draft Financial Plan explains:

“The pre-mitigation deficit of £49.4m driven by the following major items:

– [Community Health Care] CHC and other package cost pressures – £28.7m (this is driven by historic cost inflation and growth pressures above the levels funded.)

– Hospital Discharge Funding – £11.0m

– Other growth and inflationary cost pressures – £13.5m” (p112)

Norfolk & Norwich Hospitals FT April Board papers reveal and underlying deficit (2021/22 Normalised Outturn) of £39.2m (p122)

Queen Elizabeth Hospital Kings Lynn has a chronic problem of a collapsing hospital building with a roof constructed from Reinforced Autoclaved Aerated Concrete (RAAC), is and constantly having to fight for the resources to keep it moderately safe: The Trust’s April meeting heard:

QEH will receive £80m for RAAC 2022/23-2024/25 (3 year) RAAC capital programme, which is £70m less than the quantum of funding required to ensure the current hospital is fully safe and compliant. We continue to lobby for further national capital to close this gap.” (Corporate Strategy page 8)

Suffolk and North East Essex

No sign of forward planning or any detail of financial prospects in board papers of West Suffolk, Ipswich or North Essex CCGs, or East Suffolk and North Essex FT. Could this be the ICS that manages to avoid any discussion of deficits in 2022/23?

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